Cutaneous Incidence of Tuberculosis

Pulmonary - 90%

Extrapulmonary - 10%

Cutaneous - 1-1.5% Immunology

PRIMARY COMPLEX

-Ghon focus, Lymphangitis, Lymphadenitis

Tuberculin : PPD

Montoux Test: 5 T.U.

BCG vaccination CLASSIFICATION (BEYT) • Inoculation tuberculosis (Exogenous)

Tuberculous chancre Warty TB • Secondary tuberculosis (Endogenous)

Scrofuloderma Orificial TB •Hematogenous (Endogenous) Lupus vulgaris Tuberculous chancre Primary complex –Skin First episode – Non sensitized Inoculation of mycobacteria onto skin Tuberculous chancre

Tuberculous chancre + affected regional lymph nodes -Tuberculous primary complex Warty tuberculosis (Tuberculous verrucosa cutis)

Sensitized patient Exogenous infection Auto- inoculation Accidental inoculation Warty tuberculosis (Tuberculous verrucosa cutis) Sites -Exposed to trauma/ - Infected sputum Clinically Single warty papule/plaque Tuberculosis verrucosa cutis Lupus vulgaris Chronic progressive form Commonest - India Females > Males Sensitized patient Entry- Exogenous - Endogenous Lupus vulgaris Sites – Head and neck, Limbs,buttock, Mucosae Lupus vulgaris Clinically Solitary papule, Plaque, ulcer Vegetating, Tumorous Lupus vulgaris Lupus vulgaris Lupus vulgaris

Complications -Scarring -Contractures -SCC -Active internal focus Contiguous involvement of skin overlying tuberculous process -Lymphnodes Scrofuloderma

-Joint Scrofuloderma -Bone Complications -Subcutaneous nodule -Ulcers /sinuses -Undermined bluish margin -Cheesy discharge -Heals with scarring Orificial tuberculosis Active internal TB focus Pulmonary- mouth,tongue Intestinal- genitalia Anogenital- perianal Tuberculous Gumma (Metastatic tuberculous abscess)

Hematogenous dissemination Firm subcutaneous nodule Fluctuant swelling Undermined ulcer with sinuses Hematogenous Infant / Children Immunosuppressed host Bluish crop of papules, Vesicles,pustules Tuberculides

Hypersensitivity phenomenon to organisms Positive reaction to Presence of active proven TB elsewhere in body Favorable response to ATT • Tuberculids (Eruptive) - -Papulonecrotic tuberculid Lichenoid papular eruption

Lichen scrofulosorum Papulonecrotic tuberculid Symmetrical crop of necrotizing papules Healing with scarring

Erythema Induratum Nodules Painful shallow ulcers •Diagnosis of cutaneous tuberculosis

• Clinical history

Physical examination

• Investigations Diagnosis : - Direct microscopy -ZN staining Culture -LJ medium - Guinea Pig Histopathology - tuberculoid granuloma PCR Treatment 9 months Initial Phase (2 months)- -INH,RIF,PZA,E Continuation phase(7 months)- -INH, RIF 6 months

Initial Phase (2 months) :INH,RIF,PZA,E Continuation phase(4 months)- -INH, RIF DOTS

Regimen : extrapumonary T.B.